[mistermann]

Right, which increases revenue for the medical establishment, while also helping some people (and harming others) in the process. For me to consider the Democrats as the true party of the people rather than a tool of corporations, I'd want to see the cost side of health care addressed as well. My question is: was it?

[tptacek]

I don't think you're going to get anywhere productive with analyses that connect all commercial health care spending with top-to-bottom regulatory capture by the health care industry. Essentially what you'd be saying is that any system short of federally-run single-payer was a sign of corruption.

Also: this idea that the "Democrats are the party of the people" and the "Republicans are the party of corporations" is pretty silly.

The Republicans are a conservative political party. The Democrats are a coalition of blacks (~25%), latinos (~10%), women (+10% share), labor unions, and urban (but not suburban) college-educated whites. Liberals are an important component of the Democratic party (and have no home whatsoever in the GOP), but they don't run the table.

[Spooky23]

Democrats are a big tent party and idealology doesn't rule as a result. When they get ideological they pay dearly, as gay marriage demonstrated. (Lots of older white and black voters stayed home or voted GOP)

Republicans can't win the numbers game so they hammer home on right wing populism. Unfortunately, the last 30-40 years hasn't been kind to the "Main Street" centrist republicans of the past.

[sanderjd]

My impression is that the tent-restricting social issue that has held the Democrats back in recent years is abortion, not gay rights. I'd be interested to hear if you have studies or polls showing otherwise.

[pstuart]

I'd say it is God, Guns, Gays, and Gynecological Gerrymandering.

[zanny]

On one hand, the Democrats did not have control of congress to pass whatever they wanted when the ACA was passed. On the other hand, the Democratic party of the US has never fought with any fervor against Republicans on pretty much anything. The closest I have seen in my lifetime to democratic resistance was to the most blatantly and obviously stupid and racist decisions Trump has made like travel bans and appointing fossil fuel and wall street banker execs and investors to every cabinet position. In the Bush years, there was practically no resistance at all. Bipartisan support for the evil Patriot Act and disastrous No Child Left Behind. No adherence to any ideology or conviction.

Probably the most important realization for the average American in the current political climate is how no party establishment represents you. Both have their sponsors, and none of them are the American people. Individual politicians might have more empathy than others and some might try to help the common man more than another, but they all still have their bosses and despite whatever rhetoric we throw around in almost every election (aside the scant few in contested states and counties) the people are not holding their leash, so they don't work for you.

It is like climate change. It doesn't matter how you want to argue about solving it, it is simply acknowledging the reality that has to happen first and moving on from there on a unified foundation of fact.

[tptacek]

Even if we just stay on the subject we're talking about here it's easy to rebut this notion that the Democrats don't fight the Republicans.

A lot of people forget that the GOP does not, as a political party, believe in universal coverage. Moving the country closer to universal coverage is not a GOP political objective. What is a GOP objective is minimizing federal interference and involvement with business. Health care is something like 15-20% of the entire economy, so the GOP's stated objectives run directly counter to universal coverage.

And yet, repeated efforts to eliminate the ACA have all retained policies built around universal coverage, including a massive federal expenditure in Medicaid (block granted or otherwise) and an extremely intrusive regulatory requirement for guaranteed issue insurance, something that only Ted Cruz has tried to push back on.

If that's not a win for the Democrats it's hard to imagine what plausible outcome would be. Nothing that involves 15-20% of the American economy will be simple, or will happen in one legislative session.

[zanny]

Is that the Democratic party fighting the GOP, or just the GOP realizing that if they start throwing people off healthcare, especially those that both need it most and represent their most substantial voting block (middle aged, white, poor midwesterners and southerners) no amount of campaign dollars will keep them in office. They would probably never turn blue, but the GOP establishment would primary them out of their own reelections for how unpopular they would be.

[ComradeTaco]

Obamacare only reduced the growth of healthcare costs, it did not stop the growth. The approach that most democrats believe would reduce cost is single payer or Medicaid for all.

[0xbear]

As far as I can tell by looking at my premiums, it actually significantly sped up the growth of costs. I don't know how anyone could argue otherwise with a straight face.

[tptacek]

That's not the cost we're measuring! We're measuring cost on the macro scale, in terms of the percentage of the economy spent on health care and, in particular, the percentage of the federal budget spent on health care entitlements. That's the cost curve we're talking about bending, because the pre-ACA projections were literally prima facie untenable.

Any number of effective cost-saving measures could be passed that would have the effect of increasing your premiums.

[0xbear]

You can measure whatever you like, but my costs have gone up nearly threefold and my plan is worse now than it used to be. I'm not interested in solving world peace here. I just want to understand why insuring a relatively healthy family of three under a very high deductible plan costs $1700/mo, and why is it now illegal to not go along with this ridiculous rip off.

[tptacek]

Your plan was already going up before the ACA was proposed, even if you were in medium or large group markets. (My firm offered health insurance to employees in California, New York, and Illinois from ~2006-2012.) Family health insurance on the group market was something like 1100-1200 pre-ACA.

If you're paying for your own insurance, you're in the individual market, which is significantly more expensive, and what you're seeing is, in part, the market absorbing the cost of guaranteed issue, something we decisively did not have before the ACA, when health insurers could lock people out of coverage on suspicion of a medical condition, and later rescind care. Pre-ACA and post-ACA insurance is for that reason also not an apples-apples comparison.

[yourapostasy]

> ...you're in the individual market...

Is the actuarial and outcomes data corpus of the health insurance industry so bad that it makes actuarial sense to segment the markets to individual, medium group, large group, etc.? I've always wondered what the explanation is for so many cohorts.

Are state insurance regulations preventing medical insurance providers using more sophisticated risk modeling to create larger pools, or co-marketing with life insurance companies that gather pretty detailed data on individuals before underwriting?

[chrishynes]

Yep, prices were rising before ACA and continued to rise thereafter. I'm not sure on the rate of increase, but the absolute levels are getting to the impossible.

Regardless of the cause, it's extremely frustrating to be hit with such a large monthly bill for rather poor coverage. I'm not quite as bad off as 0xbear, but we're at $1550/mo for a family of three for much crappier coverage than we had a few years back.

Here in Phoenix we've seen double digit increases every year for years, and are down to a single provider on the individual market.

Paying $18k/yr before you even use a plan is insane. Use it at all and you're looking at $20 or 25k total, with coverage limits not really kicking in to stop the bleeding until you've shelled out 30k or so.

Somebody making $80k/yr just hits the subsidy payout and is spending 20-40% of income on health care. Unsustainable.

Argue the whys all you want, these sky high rates have to change.

[seanmcdirmid]

This is why Switzerland doesn't have a group market. Everyone is forced into the individual market, which makes individual polices cheaper (I.e. You can't get health insurance from your job).

[isostatic]

$1700 a month would be £5,440 a year per person.

The NHS costs about £3,500 a year per person.

[0xbear]

The costs don't end there, though. Other than preventative care, you're also covering the first $6k or so in costs, though the insurance company will negotiate them down for you from the initial insane levels to something merely causing headaches and indigestion. I've yet to pay more than $6k per year, so essentially I'm paying the remaining 20k for the benefit of others. Not even when I broke my ankle a few years ago did the (negotiated) bills total up to more than $10k or so.

[KekDemaga]

Unfortunately for the DNC, the costs many voters were measuring last November wasn't healthcare spending compared to GDP it was actual out of pocket costs that have risen dramatically for many working class Americans.

[tptacek]

Can you cite a source for that claim?

[KekDemaga]

You need a source for "people care more about their family budgets than percentages of GDP spent on healthcare"? Take a look on how the middle class voted last election.

As for the increase premiums are up 25% in 2017 alone. At the same time deductibles are also rising, its much more money for much less coverage if you are unlucky enough to make over 50k a year or so.

http://fortune.com/2016/10/25/obamacare-insurance-premiums-2...

[dankohn1]

Because premium growth actually has slowed since Obamacare was passed: http://www.factcheck.org/2015/02/slower-premium-growth-under...

[tptacek]

... and this underplays the effect, because the plans being sold under the ACA have a higher cost basis for insurers than pre-ACA plans do. You can easily observe this for yourself if you're in a major insurance market by calling up an insurer and asking for prices on non-ACA-compliant plans, which are still sold.

[rdtsc]

> If the RNC wanted to show what has happened to employer-sponsored premiums under the Affordable Care Act, it should have started the clock in 2010, the year the law was passed. But that makes Obama look better. The rate of growth in average premiums from 2010 to 2014 is 22 percent.

That's why factcheck should not be used to check... facts. Just as they claim the RNC have twisted this and that to make themselves looks better factcheck is twisting things here as well, to make someone else look better. Health insurance providers had raised premiums in anticipation of the vote and the legislation passing. So it's specifically important to look not at 2010 when it was signed into law but a few years below when there was this uncertainty about it. One way market deal with uncertainty is to hedge their bets. "Not sure what will happen, but this might pass, and why don't we just raise the rate now" kind of idea.

I've heard this directly from the health insurance representative who came and told us told us, "sorry but rates are going up sharply because we anticipate this new legislation".

[seanmcdirmid]

They anticipated Obama care in 1999? Obama only took office in 2009.

[rdtsc]

Not they didn't.

But they did during 2009. By July, a number of bills were already approved by committees in the House. And the Fall is usually when the companies get prices for the next year. So it went up sharply then. Then in again in 2010. Price is not always comparable because the level of coverage had also changed. We had to get new plans and while they covered some mandatory free procedures and didn't have lifetime maximum, they had also bigger deductibles and a reduction in options and procedures covered.

[0xbear]

Of course they do. Raise the deductible 5-10x and you can claim some pretty interesting "premium reduction" numbers.

[tptacek]

Deductibles haven't 5x'd (let alone 10x'd) under the ACA, which, for what it's worth, caps deductibles. Before Blue Cross made it annoying to do this, we did the standard HSA+HDHP plan (most young families should HSA+HDHP), and it was a little annoying getting a bronze plan from BCBS with a deductible high enough to qualify as an HDHP for our HSA.

[somecontext]

For some context, the Kaiser family foundation's 2016 Employer health benefits survey available at http://www.kff.org/report-section/ehbs-2016-summary-of-findi... suggests that the average in-network deductible for a single worker has increased from $917/year in 2010 (when the ACA was passed) to $1,478/year in 2016 -- not adjusted for inflation. While more people are using high-deductible plans, the growth in any specific plan type (eg, HMO) is about the same.

Without adjusting for inflation, this growth is ~60% growth in 6 years, or a doubling time of ~9 years. After adjusting, it's more like 40% over the same 6 years or a doubling time of ~12 years.

[dankohn1]

The article I linked to includes links to peer-reviewed research by the Kaiser Family Foundation. They look at the actuarial value (how much of your health costs the plan actually covers) to compare apples-to-apples. If you care about these subjects, I really encourage you to dive in and learn about them, rather than throwing out unsubstantiated anecdotes.

[dboreham]

There are a couple of forces at work: 1. Medical folks charge more over time, for...reasons. 2. Previously insurance could be sold tailored to the customer's ability to pay; but that insurance didn't actually cover many useful things and had a low cap (hence was almost worthless). ACA disallowed that and made insurance industry offer policies that cover the stuff a regular person needs covered.

So you could have the impression that you had "cheap insurance" as long as you never need to have significant healthcare paid for.

[kobeya]

I made significant use of my healthcare pre-ACA ($30k-$50k charges before insurance). All of it was in-network, covered, and a small annual premium.

The very year ACA took effect my health plan was canceled, my doctor went off-network, my new plan had 3x the annual premium and has grown 30% year over year, as have deductibles, and I fight tooth and nail every single charge to make sure it is in network and covered.

Yes, one anecdote is not data. But there is no more validity to the politician's lie that I can "keep my health plan, keep my doctor, and health care costs will go down."

[will_brown]

In Florida, Blue Cross Blue Sheild had a plan called Go Blue pre ACA/Obamacare, it was a kind of bare minimum coverage but monthly premiums were like $80 and BCBS of Florida carries one of the best reputations and has one of the largest networks of providers.

Something like 80,000 Floridans lost that policy because it didn't carry the minimum services under ACA/Obamacare. But it wasn't just losing the policy, they were never able to afford the new blue cross blue sheild policies, having to purchase from a new insurer most of whom had reputations as fly by night operations (many not existing before ACA and shutting down 1 and 2 years in), and finally losing the good BCBS network.

Here is a copy of the actual letter sent out by BCBS when they had to cancel the policy: https://www.floridablue.com/blog/my-policy-being-canceled-no...

[chrishynes]

"The very year ACA took effect my health plan was canceled, my doctor went off-network, my new plan had 3x the annual premium and has grown 30% year over year, and I fight tooth and nail every single charge to make sure it is in network and covered."

Same here, and I hear the same exact story from most people I talk to. Plans dropped, premiums skyrocketing. Here in Phoenix we've got a single insurer left, and we'll see if we have anybody next year.

What I haven't seen is stories of average joes who were substantially helped by ACA. Sure, if you didn't have coverage before by cost or pre-existing condition, or get subsidies now, maybe you're happier. But the vast middle class, not so much.

[drewbuschhorn]

Post ACA I'm able to get my wife insured (congenital heart issue fixed forever at 14, still used to deny her coverage at 27), and my premiums dropped. We're rather firmly middle class, pretty sure I didn't qualify for any health subsidies, I think student loan deduction and mortgage were it.

So there's a face for you, 32 year old, healthy, middle class, white woman who likes cats, rides horses, and has a pet bearded dragon who she talks to in a baby voice can get regular cancer screenings because of ACA.

[Frondo]

Average joe here: pre-ACA, I was uninsurable. My pre-existing condition was having had an organ removed in my 20s. No one would insure me when I went to buy it.

Post-ACA, I could once again buy health insurance.

I consider no longer being locked out of the US medical system a substantial help.

[kevinmchugh]

My partner is middle-class and was able to pursue education and a career more freely because she could remain on parent's isurance until age 26. By the time she hit 26, she was on her employer's insurance.

Consider also the not middle-class recipients of medicaid expansion.

[selllikesybok]

Individual, or group plan?

[neuronexmachina]

If you're curious, the non-partisan KFF has pretty comprehensive data on how average premiums for single and family coveraged have changed from 1999-2016. The increase is pretty darn linear: http://www.kff.org/report-section/ehbs-2016-section-one-cost...

[mcv]

I recently read that while 80% of Democratic voters support single payer, their members of Congress prefer something that keeps insurance companies in the loop snd profits high for the medical industry. Presumably because of donations.

If that's the case, then the difference between Democrats and Republicans is that the Dems want to insure the poor while still ensuring high profits for the industry, while the Republicans want to screw the poor while ensuring high profits for the industry. They differ on one very important issue, but are still mostly the same.

Actually reducing medical costs requires a far more thorough overhaul of the system.

[dgfgfdagasdfgfa]

> For me to consider the Democrats as the true party of the people rather than a tool of corporations

It hasn't been like this since LBJ. Both parties are completely driven by corporate lobbies. All that differ are the excuses why.

[hnbroseph]

there is no 'party of the people' in the US. or if there is, their political clout is at best described as 'trivial to nonexistent'.